Survival After Locoregional Recurrence or Second Primary Breast Cancer: Impact of the Disease-Free Interval

PURPOSE: Axillary lymph node status is the single most important prognostic variable in the management of patients with primary breast cancer. Yet, it is not known whether metastasis to the axillary nodes is simply a time-dependent variable or also a marker for a more aggressive tumor phenotype. The purpose of this study was to determine whether nodal status at initial diagnosis predicts outcome after relapse and therefore also serves as a marker of breast cancer phenotype. PATIENTS AND METHODS: Survival experience after first relapse in 1,696 primary breast cancer cases was analyzed using Cox proportional hazards regression. The following explanatory variables and their first-order interactions were considered: number of axillary lymph nodes involved (zero v one to three v four or more), hormone receptor status (any estrogen receptor [ER] negativity v ER negativity/progesterone receptor positivity v other ER positivity), primary tumor size (< 2 cm v 2 to 5 cm v > 5 cm), site of relapse (locoregional v distant), disease-free interval (< 1.5 years v 1.5 to 3 years v > 3 years), adjuvant endocrine therapy (none v any), adjuvant chemotherapy (none v any), and menopausal status (pre-, peri-, or postmenopausal). RESULTS: Axillary lymph node status, site of relapse, and hormone receptor status were all highly significant as main effects in the model. After adjustment for other variables, disease-free interval alone was only modestly significant but interacted with nodal status. After disease-free interval, hormone receptor status, and site of relapse were accounted for, survival after relapse was poorer in node-positive cases, when compared with node-negative cases. The hazard ratios for patients with one to three and four or more involved nodes were 1.2 (95% confidence interval [CI], 0.8 to 1.9) and 2.5 (95% CI, 1.8 to 3.4), respectively. CONCLUSION: Patients with four or more involved nodes at initial diagnosis have a significantly worse outcome after relapse than node-negative cases, regardless of the duration of the disease-free interval. We conclude that nodal metastasis is not only a marker of diagnosis at a later point in the natural history of breast cancer but also a marker of an aggressive phenotype.

Download Full-text

Pulmonary resection and systemic lymph node dissection in a patient with breast cancer who had a 33-year disease-free interval

World Journal of Surgical Oncology ◽

10.1186/s12957-015-0565-y ◽

2015 ◽

Vol 13 (1) ◽

Author(s):

Degang Yin ◽

Guofei Zhang ◽

Lufeng Zhao ◽

Ying Chai

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Pulmonary Resection ◽

Node Dissection ◽

Disease Free Interval ◽

Free Interval ◽

Disease Free

Download Full-text

Abstract PS6-10: Risk estimation of locoregional recurrence, distant metastasis and second primary breast cancer in early stage breast cancer patients: The INFLUENCE 2.0 nomogram

10.1158/1538-7445.sabcs20-ps6-10 ◽

2021 ◽

Author(s):

Sabine Siesling ◽

Vinzenz Völkel ◽

Tom Hueting ◽

Teresa Draeger ◽

Marissa C van Maaren ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Distant Metastasis ◽

Primary Breast Cancer ◽

Locoregional Recurrence ◽

Early Stage ◽

Risk Estimation ◽

Early Stage Breast Cancer ◽

Second Primary ◽

Breast Cancer Patients

Download Full-text

Wodurch wird der Zeitpunkt des Auftretens eines Lokalrezidivs beim Rektumkarzinom beeinflußt? Konsequenzen für die Nachsorge / Factors Influencing the Disease Free Interval in Patients with Locoregional Recurrence of Rectal Carcinoma. Consequences for Follow-Up

Deutsche Gesellschaft für Chirurgie - Panta Rhei — Umdenken — ◽

10.1007/978-3-642-56458-1_39 ◽

2001 ◽

pp. 128-128

Author(s):

S. Merkel ◽

T. Meyer ◽

W. Hohenberger

Keyword(s):

Rectal Carcinoma ◽

Locoregional Recurrence ◽

Disease Free Interval ◽

Factors Influencing ◽

Free Interval ◽

Disease Free

Download Full-text

Re-irradiation in head and neck cancers: an Indian tertiary cancer centre experience

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002497 ◽

2014 ◽

Vol 128 (11) ◽

pp. 996-1002 ◽

Cited By ~ 6

Author(s):

S Mallick ◽

A K Gandhi ◽

N P Joshi ◽

S Pandit ◽

S Bhasker ◽

...

Keyword(s):

Head And Neck ◽

Recurrent Disease ◽

Progression Free Survival ◽

Second Primary ◽

Disease Free Interval ◽

Free Survival ◽

Median Progression Free Survival ◽

Free Interval ◽

Second Primaries ◽

Disease Free

AbstractObjective:To explore the treatment outcomes of patients treated with re-irradiation for recurrent or second primary head and neck cancer.Method:An analysis was performed of 79 head and neck cancer patients who underwent re-irradiation for second primaries or recurrent disease from January 1999 to December 2011.Results:Median time from previous radiation to re-irradiation for second primary or recurrence was 53.6 months (range, 2.7–454.7 months). Median age at diagnosis of first primary was 54 years. Median re-irradiation dose was 45 Gy (range, 45–60 Gy). Acute grade 3 or worse toxicity was seen in 30 per cent of patients. Median progression-free survival for recurrent disease was 15.0 months (95 per cent confidence interval, 8.33–21.66). The following factors had a statistically significant, positive impact on progression-free survival: patient age of less than 50 years (median progression-free survival was 29.43, vs 13.9 months for those aged 50 years or older; p = 0.004) and disease-free interval of 2 years or more (median progression-free survival was 51.66, vs 13.9 months for those with less than 2 years disease-free interval).Conclusion:Re-irradiation of second primaries or recurrences of head and neck cancers with moderate radiation doses yields acceptable progression-free survival and morbidity rates.

Download Full-text

HER-2 status of the primary breast cancer in patients with relapse at least five years after the initial diagnose

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10631 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10631-10631

Author(s):

Z. I. Tomasevic ◽

D. Jovanovic ◽

L. Radosevic-Jelic ◽

Z. Tomasevic ◽

S. Vasovic ◽

...

Keyword(s):

Breast Cancer ◽

Breast Carcinoma ◽

Contralateral Breast ◽

Late Relapse ◽

Primary Breast Carcinoma ◽

Disease Free Interval ◽

Free Interval ◽

Her 2 ◽

Time To Relapse ◽

Disease Free

10631 Background: HER-2 status of the primary breast carcinoma in the subgroup of patients who relapsed after many years is not well known. The aim of this paper is to determine the HER-2 status of the primary breast cancer in patients with late relapse, defined as local recurrence, distant metastases or carcinoma in the contralateral breast, at least five years after the initial diagnosis Methods: During six month period (June-November 2005) 1256 patients were diagnosed with primary or relapsed breast cancer at the IORS. HER-2 (HercepTest, DAKO) status was determined on the archived pathological specimens of patients with late relapse. Results: One hundred eleven patients (111/1256; 8,8%) were diagnosed with late relapse. At the time of the initial diagnose, majority of patients have been treated for early breast carcinoma. Median age at the initial diagnose was 50 years (33–74). Initial tumor characteristic were: ductal carcinoma 49%; lobular carcinoma 41%;cancer mastitis 6,5%;not reported 3,5%; T1 34%; T2 52%; T3 4,5%; T4 6%;unknown 3,5%; Nodal status: positive 73,5%; negative 23%;not reported 3,5% Steroid receptor status: ER and/or PR positive 59%; both negative 14%; unknown 27%. Median time to relapse is 7 years, (range 5–29), the most frequent first relapse sites were: local recurrence (22%); carcinoma of the contralateral breast (18%); bone metastases (18%). Archived pathological specimens are identified for 63/111 (56,7%) patients and HER-2 status of the those primary breast carcinoma is: 0+ 36,5%; 1+ 34,9%; 2+ 9,5%; 3+ 14,2%; Thirty four patients (30,6%) had disease free interval 10 or more years, and HER-2 3+ in this subgroup is 17,6% (6/34). Conclusions: Long disease free interval in breast cancer patients is usually explained by initial more favorable cancer characteristics. Still, a significant percentage (14,2%) of our patients with median time to relapse of 7 years, initially had breast cancers with HER-2 3+. No significant financial relationships to disclose.

Download Full-text